“I realise that it is a rare privilege to be present and to serve those who are approaching their unmaking. I was discovering that I was not afraid of death; rather, I was in awe of it, and of its impact on our lives.”
Perfect for fans of When Breath Becomes Air, With the End in Mind is a collection of case studies about dying from Dr. Kathryn Mannix, a specialist in palliative care. Far from being melancholy (though I’ll admit I shed a tear or two), this collection is a hopeful and comforting insight into what it means to reach the end of one’s life and how we should reclaim the lost art of dying.
For someone who has not had much experience with the death of close friends or family, it was interesting to consider my own feelings on this subject. Fear? Denial? Both are there. I tried to recall conversations with anyone about my own death or the death of loved ones and could only remember odd snippets asking my parents and fiancé if they wanted to be cremated or buried; something I felt I had a responsibility to know. Nothing about the actual act of dying.
It is precisely this lack of conversation that Mannix is trying to change with this book. Despite all of the benefits the advances in medicine have brought us, we have only postponed the inevitable, and in doing so, lost the natural expectation and understanding of death.
I found Mannix’s prose to be lyrical and soothing. Just like any good doctor, she meets your concerns from the off, with an early section about what to expect and how to read this book. Is it sad? Yes. Irene’s husband was the first to make me cry and we meet him in the first chapter. Was it so sad that I couldn’t continue? Not in the slightest. I felt like I was taking a natural journey, being introduced to a daunting subject by a wise and open teacher. Mannix incorporates stories of her own experience of the deaths of friends and family members, as well as how she and her husband tackled the issue of how and when to explain death to their children. At the end of each section is a “Pause for Thought” with open questions and conversation starters, designed to get us talking. This is not about Mannix and her career in palliative medicine, this is a deliberate challenge to do better in how we approach the end of our lives. A friend joked with me that this was not the most festive read I could have chosen for the Christmas period. Finishing it a couple of days before the end of December, I had a new sense that death could be more like the end of the year, taking stock of everything we’ve done and looking on to the next journey. Whether we believe in an afterlife or not, perhaps if we approached dying like we do New Year (the celebratory vibe more than the actual boozing), we might be less afraid of it.
“Enabling people to be architects of their own solution is key to respecting their own dignity. They are only in a new phase of life; they have not abdicated personhood.”
Another challenge that the author lays down is in how we treat the elderly and terminally ill. The quiet respect Mannix and her colleagues give to their patients without question is a subtle defiance against a culture that writes people off once they cease to become ‘useful’. In ignoring death, we also ignore those who are entering that last phase of their lives. One cannot help but wonder if a more open conversation about death would result in more consideration for the dying, and better investment in social care facilities that treat the elderly and unwell with the dignity and respect they are owed.
The fact that all of us will encounter death at some point in our lifetime is the reason why everyone should read this book. Just as everyone will have their own, unique experience, I think everyone will find something in this book that will speak to them. For me, recently engaged and planning a wedding, the cases where Mannix was treating patients who were afraid to leave their husbands or wives were particularly emotional for me, tapping into fears of committing my life to one person and losing them too soon. For another reader it could be the cases where patients were afraid to die in pain; for another, the patients afraid to live in an intolerable state, thanks to a degenerative illness. There is truly something for everyone here.
“It’s your life that you are working on finishing well. It’s a mighty piece of work. Give it the attention and the time you deserve.”
5/5 stars for a profound and hopeful book about remembering the lost art of dying, and in doing so, remembering how to live.
With the End in Mind: Dying Death and Wisdom in an Age of Denial by Kathryn Mannix is out now in hardback, and released on Kindle on 4th January. Thank you to William Collins for providing me with a digital Advanced Readers Copy via NetGalley UK, in exchange for an honest review.
Martha Is 
Leave a Reply